238926 Removal of formula sample packs from an urban hospital: Associated outcomes in a real world setting

Tuesday, November 1, 2011: 5:24 PM

Anne Merewood, PhD, MPH, IBCLC , Division of General Pediatrics, Boston Medical Center, Boston, MA
Xena Grossman, MS, RD , Division of General Pediatrics, Boston Medical Center, Boston, MA
Krystal Hunter, MBA , Biostatistics Group, Cooper University Hospital, Camden, NJ
Amudha Palaniappan, MD , Department of Pediatrics, Cooper University Hospital, Camden, NJ
Elyse Kadokura , The Breastfeeding Center, Boston Medical Center, Boston, MA
Barry Milcarek, PhD , Division of Biostatistics, Cooper University Hospital, Camden, NJ
Lori Feldman-Winter, MD, MPH , Department of Pediatrics, The Children's Regional Hospital at Cooper-UMDNJ-RWJMS, Camden, NJ
  
     
Background: 91% of US hospitals distribute industry-sponsored formula sample packs to new mothers in violation of WHO recommendations. In randomized controlled trials, formula sample packs have been shown to undermine breastfeeding duration and exclusivity. No studies have examined outcomes associated with discontinuing formula sample pack distribution in a real-time hospital setting. Goals: To assess the impact of removing formula sample packs on breastfeeding rates and hospital practices. Methods: We enrolled new mothers into a prospective cohort study at Cooper Hospital (NJ) from 2009-10. A control group received industry-sponsored formula sample packs traditionally distributed by the hospital for 6 months; sample packs were then removed and the intervention group received a non-industry, Cooper hospital discharge bag for 6 months. Research assistants blinded to the study design called subjects weekly for 10 weeks to determine feeding practices. Survival curves were created for any and exclusive breastfeeding over time among control and intervention mothers. Hospital practices were also assessed. Results: We enrolled 527 breastfeeding women (284 pre and 243 post intervention). Survival analysis found a lower rate of breastfeeding cessation post intervention (p=0.048). Pre-intervention, at 10 weeks, 61% of women reported receiving formula in a discharge bag; post intervention, 28% reported receiving formula in the bag. Pre intervention, 51% of women reported receiving bottles of formula to take home; post intervention, 56% reported receiving them. Conclusion: Removal of sample packs was associated with increased duration of any breastfeeding. Despite a policy change, women continued to receive formula samples in discharge bags, presumably placed there by hospital staff. Women also continued to receive bottles of formula to take home. The effect of the intervention may have been stronger had it not been contaminated by such practices.

Learning Areas:
Ethics, professional and legal requirements
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
The learner will be able to identify the risks of formula sample pack distribution The learner will be able to describe outcomes associated with removal of formula sample packs from the hospital

Keywords: Breast Feeding, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Co-PI on this study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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